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Postmortem: The Doctor Who Walked Away
Postmortem: The Doctor Who Walked Away
Postmortem: The Doctor Who Walked Away
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Postmortem: The Doctor Who Walked Away

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"This is my story and the stories of other doctors who chose to walk away. Ours is a private anguish filled with the niggling suspicion that we should have been stronger, more committed, more able to handle the daily realities of practising medicine in South Africa."

As a young medical student from Soweto, Maria Phalime had high expectations for life as a doctor. Then she started to practise and was confronted with inhuman hours, overflowing emergency rooms, poor resources and little support.

After nine years of study and four years practising, she hung up her stethoscope, turning her back on a long-cherished dream. As she goes in search of answers, she speaks to other doctors who gave up medicine and uncovers common issues ailing the health sector.

A moving personal account that exposes the pressures that come with being a doctor in South Africa.
LanguageEnglish
PublisherTafelberg
Release dateApr 20, 2014
ISBN9780624057611
Postmortem: The Doctor Who Walked Away
Author

Maria Phalime

Maria Phalime completed the Get Smarter/Random House Struik Nonfiction Story Course under acclaimed author Mike Nicol. In 2013 her novel for teens, Second Chances, was the English language category winner of the Maskew Miller Longman Literature Awards. She is the recipient of the inaugural City Press Tafelberg Nonfiction Award. This award sponsors authors to research and write a work of nonfiction. It is granted annually and promotes nonfiction writing on subjects of significance to South African society. Born and raised in the Johannesburg township of Soweto, Maria moved to Cape Town in 1991 to pursue her studies at the University of Cape Town, from which she graduated with degrees in Science and Medicine. She worked as a general practitioner in South Africa and the United Kingdom, before leaving medical practice to pursue non-clinical interests. In 2010 she found her voice as a writer.

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  • Rating: 5 out of 5 stars
    5/5
    Profoundly insightful and relatable. In a field as professional and stoic as medicine such insights are rarely articulated. This book hits the nail on the head over and over again as it sheds light on key issues facing the junior doctor in SA both intrapersonally and professionally.

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Postmortem - Maria Phalime

Part I

A Dream

1 | Asive

His name was Asive and he was HIV positive. I met him when I was working at Red Cross War Memorial Children’s Hospital in 1998.

It always felt good arriving at Red Cross. It certainly was a change from the stiffness of Groote Schuur Hospital, the tertiary teaching hospital where Dr Christiaan Barnard had performed the first human heart transplant in 1967. Groote Schuur is one of the two academic hospitals in the Western Cape, a world-renowned centre of specialised patient care, teaching and research. The hospital was officially opened in 1938 and since then it has maintained its reputation as a training ground for South Africa’s best doctors and nurses. As a medical student at the University of Cape Town, Groote Schuur had become my second home, although I had yet to get used to its traditions and strict hierarchy.

Ward rounds at Groote Schuur were a sight to behold. Throngs of doctors in white coats would wander from ward to ward, stopping at selected patients’ beds to discuss diagnoses, agree on treatment options and share information on the latest medical advances and technologies. There was a definite pecking order to these processions, with the specialists leading up front while the junior doctors followed closely, notepads and pens in hand to jot down notes and take instructions. The students would trail behind nervously, desperately hoping to remain inconspicuous in the sea of white. The last thing any of us wanted was to be asked a question.

Red Cross was completely different. For one thing, white coats were seldom worn as they made the children nervous. You were more likely to see doctors wearing brightly coloured, cartoon-character ties, or with small furry toys attached to the ends of their stethoscopes. The mood at Red Cross was different too. Nobody seemed to take themselves too seriously, and there was very little room for observing strict traditions. How could you, when your patients could suddenly begin crying uncontrollably in the middle of a ward round?

I was feeling buoyant when I drove onto the hospital’s Rondebosch premises that Monday morning. I had a spring in my step as I walked to the medical ward, and I exchanged cheerful greetings with the staff and smiled as I strode past the colourful murals that adorn the walls.

I was immediately greeted by the sound of a crying baby. And not just the usual I need a nappy change kind of crying. This was more like Im pissed off and I want the world to know about it!

Who’s that? I asked my colleague Toni*, gesturing in the direction of the screaming.

He’s been doing that all weekend, she said, rolling her eyes. Unlike me, Toni had been on call that weekend, and it looked like it had been a rough one. No doubt this particularly vocal pair of lungs had had something to do with it. I walked over to the cot, curious to put a face to the noise. I instinctively reached for the folder at the end of the bed and scanned it for some background information – boy, aged two, HIV positive, diagnosis: pneumonia.

I peered into the cot. He was thrashing his arms and legs about, and screaming his little lungs out. His body was the size of a six-month-old’s, its growth retarded by the virus that was slowly eating away at him. He was so absorbed in his crying that he didn’t see me standing there, so I stuck my head further into the cot, until my face was just a few centimetres from his.

He suddenly noticed me and stopped crying. Just stopped and stared, and then after about ten seconds his face broke into a broad smile. I smiled back at him; it was love at first sight.

I noticed Toni looking over at us curiously. What did you do? she asked.

I don’t know, I answered. I didn’t know what I’d done to earn such a beaming smile; maybe I reminded him of someone he loved. He’d been brought into Red Cross by his grandmother. His mother had left shortly after he was born, apparently to Johannesburg, though nobody had heard from her since. She was young, unmarried, and I imagine terrified of the disease she had passed on to her son. We knew nothing of his father.

Asive stayed in the ward for two weeks while his pneumonia was being treated. Every so often I would catch him sitting up, looking at me. And whenever our eyes met, he would smile and giggle joyfully. I felt proud to have been singled out for his attention, and I enjoyed our special connection. At every opportunity I got, I would walk over to his cot for a cuddle and a play.

When he was discharged, I was a little sad to see him go. I had grown attached to him and would miss the little games that had become our own. But more than that I was happy, relieved that he had responded to the antibiotics. At the time all we could do was fight the opportunistic infections caused by HIV; antiretroviral therapy was not yet readily available for use in public hospitals.

Asive came back about four weeks later, just as my time at Red Cross was coming to an end. He had developed meningitis, and he looked like he had aged considerably in the interim. He didn’t recognise me, he didn’t smile and he didn’t cry. He just lay in his cot, passively enduring the treatment that was being piped into his emaciated body. We all knew that Asive had reached the end of the road, and all we could do was keep him as comfortable as possible until the end.

He was still at Red Cross when I moved on to my next posting, and I hoped that when the time came, he would at least be allowed to die at home.

I was a fifth-year medical student when I met Asive, and until then I believed that I could cure people, make them well again. But Asive brought me face to face with a harsh reality that would be reinforced over and over again during my brief medical career – not everyone is going to get better, some people will just die. I’ve thought about little Asive often over the years and wondered whether this was where it all started, my gradual falling out of love with medicine.

They are everywhere, the Asives. They come in varying shapes and sizes, young and old, but they have one thing in common – they are desperate and dying, the victims of a dysfunctional health system, of poverty and destitution. They come looking to doctors, nurses and other health care professionals to ease their pain and suffering.

But what happens when those charged with their care are no longer able or willing to come to the rescue with whatever limited resources they have at their disposal?

I left medical practice in 2004, just four years after I graduated. This is my story and the stories of other doctors who chose to walk away. Ours is a private anguish filled with the niggling suspicion that we should have been stronger, more committed, more able to handle the daily realities of practising medicine in South Africa. We move on to other professions where the Asives can’t find us, and we keep our stories to ourselves. But festering wounds can’t heal. The low-grade infection lingers on, feeding off itself and threatening to engulf all around it in its toxicity. It is only when the rot is released and dead tissue is cleared away that new growth can begin.

I do not profess to be a human resources expert and my intention is not to produce scholarly work. This is also not intended as an analysis of the health sector as a whole or as a comprehensive examination of the exodus of doctors from the South African medical profession. At the same time I cannot deny that the stories contained here are a reflection of the broader health care system in the country. Many of the experiences are common to doctors across the board, to a greater or lesser degree. Indirectly, therefore, this book is also a commentary on the health sector in South Africa and the impact it has on its health care professionals.

People often ask why I left and I’ve never been able to give them a succinct response. There is so much that I leave unsaid as I dismiss their enquiry with a hasty It just didn’t work out. The time has now come for me to answer that question.

* An asterisk indicates a pseudonym.

2 | Untimely Loss

I was born in the Johannesburg township of Soweto in 1972, the younger of two children. In many ways my childhood was typical for many black children growing up in the townships during that period. My parents had settled in Soweto in 1970, the year my brother, Abbie, was born. They had met two years before, when they were both working at the Natalspruit Hospital on Johannesburg’s East Rand.

My father – who had been schooled at the Catholic St Francis College in the Mariannhill area of KwaZulu-Natal and then gone on to study towards a Bachelor of Science degree at Turfloop University, now known as the University of Limpopo – was an apprentice in the hospital’s pharmacy. My mother was a student nurse at Natalspruit. She was soft-spoken, pretty and petite – so petite that she was affectionately known as Tiny by her friends and family. When they met she was swept off her feet by the confident and sometimes boisterous person my father was. Her nursing ambitions were thwarted when she fell pregnant with my brother in her final year of study and was forced to return to her parents’ home in Soweto.

Like so many black South Africans at that time, where my family lived and worked was intimately linked to the prevailing apartheid laws. My maternal grandparents hailed from the farming town of Bothaville in the Free State. They moved to Johannesburg in the late 1930s in search of work opportunities. My grandmother initially worked as a washer woman before moving on to domestic work in one of Johannesburg’s northern suburbs. My grandfather’s efforts were somewhat more enterprising – he took advantage of his fair complexion and passed himself off as a coloured Mr Stevens, earning himself the right to own a small fleet of taxis. The venture didn’t last, however, and he worked as a driver for a furniture manufacturer until his retirement in the late 1970s.

They settled in the Western Native Township on the outskirts of Johannesburg but were compelled to uproot their young family of seven children when the apartheid government forcibly relocated them to Rockville location in Soweto. This was the house where I was born shortly before midnight on 14 November. It was my first act of defiance – my mother’s wish had been that I make my appearance the following day, her own birthday.

My father was new to Johannesburg. He grew up in the former homeland of Qwaqwa, now part of the Free State province. His family was desperately poor, and when it was noticed that he was academically gifted, a friend of the family facilitated an introduction to a foster family in Natalspruit. The respected clergyman’s family took him in and raised him as their own, and facilitated his schooling at Mariannhill.

We were a God-fearing family. At my grandmother’s house – where I spent most of my days while my parents worked – prayer was an integral part of our life. Evenings always ended with long prayers and singing, and church on Sundays was non-negotiable. My mother converted from her Methodist roots to Catholicism when she met my father, though he wasn’t much of a churchgoer. He had grown up Catholic and, though he loved the rituals and traditions of the Catholic Church, he saw little reason to observe the practice of attending mass regularly unless necessitated by an occasion such as a funeral or wedding.

As a child I didn’t feel particularly impoverished; my basic needs for food, shelter and clothing were always taken care of. It was only as I grew older and became aware of racial inequalities that I was able to appreciate the relative hardships of our daily reality. My grandmother would often refer to herself as modidi o ithatang – a proud peasant; we made the most of the little we had.

We didn’t have a house of our own until I was in high school. Until then my parents rented a garage in a neighbour’s backyard, and my mother did her best to turn the meagre single-roomed space into a home. A cupboard was used to partition the room; on one side was the space where my parents slept, and the other side served as a kitchen, dining room and TV room. Abbie and I would move the kitchen table aside after the evening meal to make our beds on the floor.

Even though I did not experience much material hardship in my childhood, my source of suffering lay elsewhere. Ours was an emotionally unstable home. My father was an alcoholic, and so much of what we did and didn’t do was determined by his level of inebriation at any given time. My mother did all she could to manage the mood swings that accompanied his drinking. I grew up surrounded by the constant static of low-grade tension, which would erupt into a full-blown tirade with hardly a moment’s notice. I drew comfort from the adoration that my brother, who was two years older than me, heaped upon me. In his eyes I could do no wrong, and having him there made it easier for me to cope with what was going on at home. He was my rock in a family that was often teetering on the verge of collapse. Abbie was more than a brother; he was an ally.

Abbie was as laid back as I was studious. He did okay at school, and he was very popular. It wasn’t particularly difficult for Abbie to get in with any crowd. He was one of those people who you instantly warmed to, with his ready smile and easy charm. I, on the other hand, excelled on the academic front. Though our childhood was fairly typical for a working-class black family in apartheid South Africa, unlike many I had two things going for me. My parents were firm believers in the value of education, and they’d saved and made sacrifices in order to send us to Sacred Heart College, a nonracial Catholic private school in the Johannesburg suburb of Observatory. I was also blessed with an enquiring mind and acute intelligence, and I diligently applied myself to my studies with considerable success.

I thrived in the school’s multicultural environment, and I immersed myself in its academic, sporting and cultural life. Many of the children at the school came from wealthy families, and I often marvelled at the luxury cars that dropped them off in the morning and the palatial mansions they called home. This was a far cry from the garage that I returned to every afternoon. I sometimes felt like an interloper in this world of wealth and privilege.

Life at home became tricky when Abbie entered his teenage years. He had many run-ins with our father, and I was often caught in the middle. On weekends he always found a party to go to, and he would stumble home at all hours of the morning. When I could, I would let him into the house when he got back, but on occasion I was given strict instructions not to. On those nights I would lie awake, tortured by the thought of him sleeping outside. But in the morning, in quintessential Abbie style, we’d find him sleeping soundly in the car or on the neighbour’s lawn, oblivious to the mental anguish his absence had caused.

When I was thirteen, he developed a habit of showing me off. He’d insist that I dress up and make myself look pretty, and then he’d take me for a walk around the neighbourhood, introducing me to all his friends along the way. I say friends but it was just about any teenage boy we met – they all seemed to know him. I never asked him why he did it, but it was a clever move. Of course he was proud of me; I could see it in the way he bragged about me to his friends. But he also understood how street law

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